Specialist Referral

You can make a referral by completing the online form below. However, if you would prefer, please feel free to give us a call on 020 8391 9222, email us at reception@hortondental.co.uk.

Patient Details

Patient First Name

Patient Last Name

Date of Birth

Patient Email

Patient Address

Contact Number

Referring Practice Details

Practice Name

Dentist First Name

Dentist Last Name

Dentist Email

Dentist Telephone

Practice Address

Type of Referral

Please select a treatment:

Further Information

Further Information & Queries

Radiographs & Clinical Photographs

If you would like to attach any radiographs, clinical photographs or any documents that you feel would be of use, please use the upload facility below.

Files Upload

Choose File(s)

Please Note: It is the referring practitioner’s responsibility to ensure that all scans and radiographs are reviewed and reported appropriately in the clinical records, in compliance with IRMER 2000 regulations. It is strongly recommended that all scans/radiographs are reported upon by an appropriately trained individual to assess for any coincidental pathology. Please let us know if you wish to make your own arrangements for the reporting.

General Dentistry

Cosmetic Dentistry

Implant & Specialist Dentistry

Patient Details

Referring Practice Details

Type of Referral

Further Information

Radiographs & Clinical Photographs

Ask the dentist!